Fill and Sign the Continuation Statement Individual Montana Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: ____________________ Company: _____________________ Address: _____________________ City: ___________________ State: ______ Zip: __________ Phone: _________________ Fax: ___________________ CONTINUATION STATEMENT--INDIVIDUAL (M.C.A.§ 71-3-531(6)(d)) COMES NOW, __________________________________ , a party which is entitled to claim a construction lien and is required to provide a Notice of a Right to Claim a Lien and would state as follows: 1. On or about the _____ day of ________________ , 20 _________ , the undersigned filed a Notice of Right to Claim a Lien. 2. T he clerk and recorder's file number of said Notice was ___________________________________ . 3. Said Notice was given to ____________________________________ , at the following address _____________________________________________ . 4. Pursuant to Montana Code Annotated § 71-3-531(6)(c) the original Notice would expire one (1) year from the date of filing on the _____ day of ________________ , 20 ______ , and contingent upon the proper filing of this Continuation Statement, should be continued for one (1) year until the _____ day of ________________ , 20 _________ . This the _____ day of ________________ , 20 ______ . ______________________________ Signature _____ _________________________ Type or Print Name Continuation Statement Page 1 of 2 STATE OF MONTANA COUNTY OF __________________ The instrument was acknowledged before me on _______________ (date), by _________________________________ (name(s)). ______________________________ Notary Public Printed Name: _________________ (SEAL) Title (and Rank): _______________ Residing at:____________________ My Commission Expires: ________________ MT § 71-3-531(6)(d) Continuation Statement Page 2 of 2